Effect of Dexmedetomidine on Maintaining Perioperative Hemodynamic Stability in Elderly Patients: A Systematic Review and Meta-analysis / 中国医学科学杂志(英文版)

Objective Dexmedetomidine is a highly selective alpha-2 adrenergic receptor agonist with sedative and analgesic properties but without respiratory depression effect and has been widely used in perioperative anesthesia. Here we performed a systematic review and meta-analysis to evaluate the effect of dexmedetomidine on maintaining perioperative hemodynamic stability in elderly patients.Methods PubMed, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched for randomized-controlled trials (RCTs) on the application of dexmedetomidine in maintaining perioperative hemodynamic stability in elderly patients from their inception to September, 2021. The standardized mean differences (SMD) with 95% confidence interval (CI) were employed to analyze the data. The random-effect model was used for the potential clinical inconsistency.Results A total of 12 RCTs with 833 elderly patients (dexmedetomidine group, 546 patients; control group, 287 patients) were included. There was no significant increase in perioperative heart rate (HR), mean arterial pressure (MAP), and diastolic blood pressure (DBP) in the dexmedetomidine group before and during the operation. In addition, the variations of hemodynamic indexes including HR, MAP, SBP (systolic blood pressure), and DBP were significantly lower in the dexmedetomidine group compared with the control group (HR: SMD = -0.87, 95% CI: -1.13 to -0.62; MAP: SMD = -1.12, 95% CI: -1.60 to -0.63; SBP: SMD = -1.27, 95% CI: -2.26 to -0.27; DBP: SMD = -0.96, 95% CI: -1.33 to -0.59). Subgroup analysis found that with the prolongation of 1.0 μg/kg dexmedetomidine infusion, the patient's heart rate declined in a time-dependent way.Conclusion Dexmedetomidine provides more stable hemodynamics during perioperative period in elderly patients. However, further well-conducted trials are required to assess the effective and safer doses of dexmedetomidine in elderly patients.

Efficacy and safety of dexmedetomidine in maintaining hemodynamic stability in pediatric cardiac surgery: a systematic review and meta-analysis

Abstract Objectives: Dexmedetomidine (DEX) is a highly selective alpha-2 adrenergic receptor agonist, which is the main sedative in the intensive care unit. This study aims to investigate the effectiveness and adverse events of DEX in maintaining hemodynamic stability in pediatric cardiac surgery. Sources: Databases such as PubMed, Cochrane, Web of Science, WANFANG STATA and China National Knowledge Infrastructure were searched for articles about the application of DEX in maintaining hemodynamic stability during and after pediatric cardiac surgery up to 18th Feb. 2021. Only randomized controlled trials were included and random-effects model meta-analysis was applied to calculate the standardized mean deviation (SMD), odds ratio (OR) and 95% confidence interval (CI). Summary of the findings: Fifteen articles were included for this meta-analysis, and 9 articles for qualitative analysis. The results showed that preoperative prophylaxis and postoperative recovery of DEX in pediatric patients undergoing cardiac surgery were effective in maintaining systolic blood pressure (SBP), mean arterial pressure (MAP), diastolic blood pressure (DBP) and reducing heart rate (HR) (SBP: SMD = -0.35,95% CI: -0.72, 0.01; MAP: SMD = -0.83, 95% CI: -1.87,0.21; DBP: SMD = -0.79,95% CI: -1.66,0.08; HR: SMD = -1.71,95% CI: -2.29, -1.13). In addition, the frequency of Junctional Ectopic Tachycardia in the DEX treatment group was lower than that in the placebo group. Conclusions: The application of DEX for preoperative prophylaxis and postoperative recovery in pediatric cardiac surgery patients are effective in maintaining hemodynamic stability, and the clinical dose of DEX is not significantly related to the occurrence of pediatric adverse events which may be related to individual differences.

Safety and efficacy of dexmedetomidine hydrochloride combined with midazolam in fiberoptic bronchoscopy in children: a prospective randomized controlled study / 中国当代儿科杂志

OBJECTIVES@#To study the safety and efficacy of dexmedetomidine hydrochloride combined with midazolam in fiberoptic bronchoscopy in children.@*METHODS@#A total of 118 children who planned to undergo fiberoptic bronchoscopy from September 2018 to February 2021 were enrolled. They were divided into a control group (@*RESULTS@#Compared with the control group, the observation group had significantly decreased MAP at T@*CONCLUSIONS@#Dexmedetomidine hydrochloride combined with midazolam is a safe and effective way to administer general anesthesia for fiberoptic bronchoscopy in children, which can ensure stable vital signs during examination, reduce intraoperative adverse reactions and postoperative agitation, shorten examination time, and increase amnesic effect.

Sedation with dexmedetomidine for conducting electroencephalogram in a patient with Angelman syndrome: a case report / Sedação com dexmedetomidina para realização de eletroencefalograma em paciente portadora de síndrome de Angelmann: relato de caso

ABSTRACT INTRODUCTION: Angelman syndrome is characterized by severe mental retardation and speech and seizure disorders. This rare genetic condition is associated with changes in GABAA receptor. Patients with Angelman syndrome need to be sedated during an electroencephalogram ordered for diagnostic purposes or evolutionary control. Dexmedetomidine, whose action is independent of GABA receptor, promotes a sleep similar to physiological sleep and can facilitate the performing of this examination in patients with Angelman syndrome. CASE REPORT: Female patient, 14 years old, with Angelman syndrome; electroencephalogram done under sedation with dexmedetomidine. The procedure was uneventful and bradycardia or respiratory depression was not recorded. The examination was successfully interpreted and epileptiform activity was not observed. CONCLUSION: Dexmedetomidine promoted satisfactory sedation, was well tolerated and enabled the interpretation of the electroencephalogram in a patient with Angelman syndrome and seizure disorder.

RESUMO INTRODUÇÃO: a síndrome de Angelman (SA) é caracterizada por retardo mental grave, distúrbio da fala e desordem convulsiva. Essa condição genética rara está associada a alterações do receptor GABA-A. Pacientes portadores de SA necessitam ser sedados durante a feitura de eletroencefalograma (EEG), indicado para fins diagnósticos ou controle evolutivo. A dexmedetomidina, cuja ação independe do receptor GABA, promove sono semelhante ao fisiológico e pode viabilizar a feitura desse exame em pacientes com SA. RELATO DE CASO: paciente feminina, 14 anos, portadora de SA, fez EEG sob sedação com dexmedetomidina. O procedimento transcorreu sem intercorrências e não foi registrada bradicardia ou depressão respiratória. O exame foi interpretado com sucesso e atividade epileptiforme não foi observada. CONCLUSÃO: a dexmedetomidina promoveu sedação satisfatória, foi bem tolerada e possibilitou a interpretação do EEG em paciente com SA e desordem convulsiva.

Effects of Dexmedetomidine Infusion on the Recovery Profiles of Patients Undergoing Transurethral Resection

Transurethral resection has been the gold standard in the operative management of benign prostatic hyperplasia and bladder tumor; however, it is associated with several complications that may cause patient discomfort. We evaluated the usefulness of continuous infusion of dexmedetomidine on emergence agitation, hemodynamic status, and recovery profiles in patients undergoing elective surgery by a randomized clinical trial. Sixty patients aged 30 to 80 yr who were scheduled for elective transurethral resection under general anesthesia were included in this study. Participants were randomly assigned to two groups (control group, group C; dexmedetomidine group, group D). A total of 60 male patients were enrolled in this study and randomly assigned to group C (n=30) or group D (n=30). The quality of emergence in group D was marked by a significantly lower incidence of emergence agitation than in group C (P=0.015). Patients in group D therefore felt less discomfort induced by the indwelling Foley catheter than those in group C (P=0.022). No statistically significant differences were found between the two groups with respect to side effects including bradycardia (P=0.085), hypotension (P=0.640), and postoperative nausea and vomiting (P=0.389). Our study showed that intraoperative dexmedetomidine infusion effectively reduced the incidence and intensity of emergence agitation and catheter-induced bladder discomfort without delaying recovery time and discharge time, thus providing smooth emergence during the recovery period in patients undergoing transurethral resection (Clinical Trial Registry No. KT0001683).

Dexmedetomidina: papel atual em anestesia e cuidados intensivos / Dexmedetomidine: current role in anesthesia and intensive care

JUSTIFICATIVA E OBJETIVOS: Atualizar e rever a aplicação da dexmedetomidina em anestesia e cuidados intensivos. Este trabalho é uma revisão abrangente dos usos clínicos, farmacologia, farmacocinética, mecanismo de ação e efeitos adversos da dexmedetomidina. CONTEÚDO: O uso efetivo de agentes sedativo-hipnóticos e analgésicos é parte integral do conforto e segurança dos pacientes. A dexmedetomidina é um potente e altamente seletivo agonista dos adrenoceptores α-2 com propriedades simpaticolíticas, sedativas, amnésicas e analgésicas, que tem sido descrito como um adjuvante útil e seguro em várias aplicações clínicas. Proporciona uma "sedação consciente" única, analgésica, sem depressão respiratória. Os usos correntes revistos incluem sedação na unidade de tratamento intensivo - UTI (adulta e pediátrica), departamento de emergência, anestesia regional e geral, neurocirurgia, sedação para procedimentos pediátricos, intubação por fibra ótica em doentes acordados, cirurgia cardíaca e cirurgia bariátrica. CONCLUSÕES: A dexmedetomidina oferece a capacidade única de fornecer sedação e analgesia sem depressão respiratória. É um agente novo com uma grande margem de segurança, excelente capacidade sedativa e moderadas propriedades analgésicas. Embora o seu amplo uso seja, atualmente, em pacientes de unidades de cuidados intensivos cirúrgicos e não cirúrgicos, a dexmedetomidina parece ter futuras aplicações promissoras nas áreas de neuroproteção, cardioproteção e renoproteção. São necessários mais estudos detalhados para definir o seu papel como sedativo em doentes críticos, neurocirúrgicos e pediátricos, como adjuvante da anestesia e como sedativo durante procedimentos.

BACKGROUND AND OBJECTIVES: To update and review the application of dexmedetomidine in anesthesia and intensive care. This study is a comprehensive review of clinical uses, pharmacology, pharmacokinetics, mechanism of action and adverse effects of dexmedetomidine. CONTENT: The effective use of sedative-hypnotic agents and analgesics is an integral part of comfort and safety of patients. Dexmedetomidine is a potent and highly selective α-2 adrenoceptor agonist with sympatholytic, sedative, amnestic, and analgesic properties, which has been described as a useful and safe adjunct in many clinical applications. It provides a unique "conscious sedation", analgesia, without respiratory depression. The current reviewed uses include sedation at Intensive Care Unit - ICU (both adult and pediatric), emergency department, regional and general anesthesia, neurosurgery, sedation for pediatric procedures, awake fiber-optic intubation, cardiac surgery and bariatric surgery. CONCLUSIONS: Dexmedetomidine offers a unique ability of providing both sedation and analgesia without respiratory depression. It is a new agent with a wide safety margin, excellent sedative capacity and moderate analgesic properties. Although its wide use is currently in patients of surgical and non-surgical intensive care units, dexmedetomidine seems to have promising future applications in neuroprotection, cardioprotection and renoprotection. More detailed studies are required to define its role as sedative in critical, neurosurgical and pediatric patients, as anesthesia adjunct and sedative during procedures.

JUSTIFICATIVA Y OBJETIVOS: Actualizar y analizar nuevamente la aplicación de la dexmedetomidina en la anestesia y en los cuidados intensivos. Este trabajo es una revisión bastante exhaustiva de los usos clínicos, farmacología, farmacocinética, mecanismo de acción, y de los efectos adversos de la dexmedetomidina. CONTENIDO: El uso efectivo de los agentes sedativo-hipnóticos y analgésicos, forma parte integral de la comodidad y de la seguridad de los pacientes. La dexmedetomidina es un potente y altamente selectivo agonista de los adrenoceptores α-2 con propiedades simpaticolíticas, sedativas, amnésicas y analgésicas, que se ha venido describiendo como un adyuvante útil y seguro en varias aplicaciones clínicas. Proporciona una "sedación conciente" única, analgésica, y sin depresión respiratoria. Sus usos más comunes ya analizados, incluyen la sedación en la Unidad de Cuidados Intensivos (UCI) (adulta y pediátrica), en Urgencias, anestesia regional y general, neurocirugía, sedación para procedimientos pediátricos, intubación por fibra óptica en enfermos despiertos, cirugía cardíaca y cirugía bariátrica. CONCLUSIONES: La dexmedetomidina ofrece la capacidad única de suministrar sedación y analgesia sin depresión respiratoria. Es un agente nuevo con un gran margen de seguridad, excelente capacidad sedativa y moderadas propiedades analgésicas. Aunque su amplio uso sea hoy por hoy, para pacientes de unidades de cuidados intensivos quirúrgicos y no quirúrgicos, la dexmedetomidina parece tener aplicaciones futuras promisorias en las áreas de neuroprotección, cardioprotección y renoprotección. Aunque de todas formas, son necesarios más estudios detallados para definir su rol como sedativo en los enfermos criticos, neuroquirúrgicos y pediátricos, como adyuvante en la anestesia y como sedativo durante los procedimientos.

Prolonged dexmedetomidine infusions in critically ill infants and children.

Objective: To present our institutional experience with prolonged dexmedetomidine (DEX) infusions in critically ill infants and children. Design: Retrospective medical chart review between January 1, 2007 and December 1, 2007. Setting: Tertiary care pediatric teaching hospital. Participants: Infants and children (up to 18 years of age) who received DEX for a duration greater than 24 hours. Main Outcome Measures: DEX dosing schema and rationale for use. Indices describing DEX efficacy and tolerability including change in patient-specific sedation scores, change in blood pressure and heart rate, and change in conventional analgesia and sedation requirements. Results: Twenty-nine patients (age 5.32 ± 6.1 y) were evaluated. DEX therapy was initiated at 0.36 ± 0.16 mcg/kg/hour. One-third of patients received a loading dose (0.5-1 mcg/kg) prior to the start of the infusion. Duration of DEX therapy was 110 ± 83 hours (range 32-378 hours; median 76 hours). Rationale for adding DEX to sedation regimens included: intent to extubate (n=12), intent to reduce benzodiazepine and opioid use (n=10), exclusive continuous sedation (n=5) and management of drug with-drawal (n=2). Sedation scores remained stable during DEX therapy. Use of conventional analgesia and sedation was generally reduced while receiving DEX. Initiation of therapy was associated with a transient, yet statistically significant reduction in HR (from 120 ± 28 bpm to 107 ± 27 bpm) (P = 0.002), but without a change in blood pressure. Conclusions: Prolonged DEX infusions were associated with a reduction in concomitant analgesia and sedation medications. DEX was well tolerated with the exception of heart rate, which decreased during the initiation of therapy but may not represent a clinically significant reduction.

Efeito sinérgico entre a dexmedetomidina e a ropivacaína 0,75 por cento na anestesia peridural / Synergistic effect between dexmedetomidine and 0.75 percent ropivacaine in epidural anesthesia

OBJETIVO: O objetivo deste estudo foi avaliar as características clínicas da anestesia peridural realizada com ropivacaína associada à dexmedetomidina. MÉTODOS: Quarenta pacientes submetidos à correção cirúrgica de hérnia inguinal ou varizes de membros inferiores sob anestesia peridural participaram deste estudo. Os pacientes foram divididos em: Grupo Controle (n = 20), ropivacaína 0,75 por cento, 20 ml (150 mg); e Grupo Dexmedetomidina (n = 20), ropivacaína 0,75 por cento, 20 ml (150 mg), mais dexmedetomidina, 1 µg.kg-1. As variáveis estudadas foram: tempo de latência do bloqueio sensitivo, dermátomo máximo de anestesia, tempo de duração dos bloqueios analgésico e motor, intensidade do bloqueio motor, nível de sedação, variáveis hemodinâmicas, analgesia pós-operatória e ocorrência de efeitos colaterais. RESULTADOS: A dexmedetomidina não influenciou o tempo de latência da anestesia nem o nível máximo do bloqueio sensitivo (p > 0,05), mas prolongou o tempo de duração dos bloqueios analgésico e motor (p < 0,05) e da analgesia pós-operatória (p < 0,05), além de determinar bloqueio motor de maior intensidade (p < 0,05). Os valores do índice bispectral foram menores no Grupo Dexmedetomidina (p < 0,05). Não houve diferença na incidência de hipotensão arterial e de bradicardia (p > 0,05). A ocorrência de efeitos colaterais (tremor, náuseas e SpO2 < 90 por cento) foi baixa e semelhante entre os grupos (p > 0,05). CONCLUSÃO: Há sinergismo evidente entre a dexmedetomidina e a ropivacaína na anestesia peridural sem que haja elevação da morbidade relacionada a associação dos fármacos.

BACKGROUND: This study aimed to evaluate clinical characteristics of epidural anesthesia performed with 0.75 percent ropivacaine associated with dexmedetomidine. METHODS: Forty patients scheduled for hernia repair or varicose vein surgeries under epidural anesthesia participated in this study. They were assigned to: Control Group (n = 20), 0.75 percent ropivacaine, 20 ml (150 mg); and Dexmedetomidine Group (n = 20), 0.75 percent ropivacaine, 20 ml (150 mg), plus dexmedetomidine, 1 mg.kg-1. The following variables were studied: total analgesic block onset time, upper level of analgesia, analgesic and motor block duration time, intensity of motor block, state of consciousness, hemodynamics, postoperative analgesia and incidence of side-effects. RESULTS: Epidural dexmedetomidine did not affect onset time or upper level of anesthesia (p > 0.05) however it prolonged sensory and motor block duration time (p < 0.05) and postoperative analgesia (p < 0.05), and also resulted in a more intense motor block, l (p < 0.05). Values of bispectral index were lower in Dexmedetomidine Group (p < 0.05). There was no difference in incidence of hypotension and bradycardia (p > 0.05). Occurrence of side-effects (shivering, vomiting and SpO2 < 90 percent) was low and similar between groups (p > 0.05). CONCLUSION: There is clear synergism between epidural dexmedetomidine and ropivacaine, further this drug association does not bring about additional morbidity.

Efeito da dexmedetomidina sobre a arritmia cardíaca induzida pela adrenalina em cães anestesiados pelo sevofluorano / Effect of dexmedetomidine on the heart arrhythmia induced by the adrenaline in dogs anesthetized by sevoflurane

Avaliou-se o efeito da dexmedetomidina sobre o ritmo cardíaco em 20 cães, sem raça definida, de ambos os sexos e considerados sadios, anestesiados pelo sevofluorano e submetidos a doses crescentes de adrenalina. Os animais foram, aleatoriamente, distribuídos em dois grupos (placebo e dexmedetomidina). No grupo placebo, os animais receberam, por via intravenosa, solução de NaCl a 0,9 por cento, na dose de 0,3ml/kg. Foram considerados dois momentos, M0 e M1, imediatamente antes e após a aplicação, respectivamente. Após 10 minutos, realizou-se a indução anestésica com sevofluorano, por meio de máscara facial vedada, até a perda do reflexo laringotraqueal. Em seguida, procedeu-se à intubação orotraqueal e a manutenção da anestesia foi realizada com a administração de sevofluorano na concentração de 1,5CAM, em circuito anestésico com reinalação parcial de gases. Decorridos 20 minutos da indução anestésica, iniciou-se a administração intravenosa contínua de solução de adrenalina a 2 por cento em doses crescentes de 1, 2, 3, 4 e 5mg/kg/min, por meio de bomba de infusão, com aumento da dose em intervalos de 10 minutos. Imediatamente antes desse acréscimo eram feitas as mensurações (M2 a M6). No grupo dexmedetomidina empregou-se a mesma metodologia substituindo-se a solução de NaCl a 0,9 por cento por hidrocloridrato de dexmedetomidina, na dose de 1µg/kg. Foram registradas as pressões arteriais, em M0 e em M2 a M6, e o traçado eletrocardiográfico, na derivação DII (M2 a M6), considerando-se para efeito estatístico o número total de bloqueios atrioventriculares (BAV) de primeiro e segundo graus e de complexos ventriculares prematuros (ESV), coincidentes com cada dose de adrenalina. Os dados foram submetidos à análise de variância seguida pelo teste de Tukey (P<0,05). Verificou-se que a dexmedetomidina interfere significativamente na condução atrioventricular levando a maior ocorrência de BAV e reduz o número de ESV nas doses infundidas de 2 e 3mg/kg/min ...

The effect of dexmedetomidine on the cardiac rhythm in twenty healthy mongrel dogs of both sexes anesthetized with sevofluorane and submitted to increasing doses of adrenaline was evaluated. The animals were randomly allotted to different treatment groups. Animals of placebo group were intravenous injected with 0.9 percent NaCl solution at 0.3ml/kg/IV. Two moments were considered, M0 and M1, the moments immediately before and after application, respectively. Ten minutes later, the dogs were anesthetized using sevofluorane via face mask until lost of their laringotracheal reflex. Then, orotracheal intubation was performed and maintenance of anesthesia was kept with 1,5MAC sevofluorane using an anesthetic circuit with a rebreathing system. Twenty minutes after anesthesia induction, continuous IV administration of 2 percent adrenaline solution was given at increasing doses of 1,2,3,4 and 5mg/kg/min., every ten minutes, respectively. The moments M2 to M6 were measured immediately before the next increase of dose. In dexmedetomidine group, the same technique was used replacing 0.9 percent NaCl by dexmedetomidine hydrochloride at 1mg/kg. Blood pressures were recorded at M0 and M2 to M6. Electrocardiography line in the derivation DII (M2 to M6) was used to observe the number of atrioventricular blocks (AVB) of first and second degrees and ventricular premature complexes (VPC). Statistic evaluation was performed by analysis of variance followed by Tukey's test (P<0.05). Dexmedetomidine significantly altered the atrioventricular conduction resulting in a higher occurrence of AVB. This drug reduced the number of VPC at 2 and 3mg/kg/min of adrenaline. After administration of dexmedetomidine, reduction of arterial blood pressure up to one hour and reduction of cardiac rate were observed